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Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.

CBT is based on the idea that some problems arise because of how you view life events, rather than because of the events themselves. CBT is a combination of:

cognitive therapy, which looks at how you think about situations, events and symptoms in your life

behavioural therapy, which focuses on how you behave in response to those thoughts

When you have CBT, you learn how to recognise negative or unhelpful thinking patterns and replace them with positive or helpful ones. You can have CBT with a therapist or use self-help books or computer programmes.

Details

Your GP may recommend CBT for several reasons. CBT is the preferred psychological treatment for anxiety disorders and depression. But it can also be used to treat other mental health disorders and physical conditions, including:

You usually have CBT for between six weeks and six months. You may have it on your own, with your partner or a family member, or in a group.

If you have individual treatment sessions, you usually attend every week or two. The number of sessions you have will depend on why you’re having CBT. Each session usually lasts for about 30 minutes to an hour.You may have follow-up therapy sessions after you finish a course of CBT to check on your progress.

If your GP thinks that you may benefit from CBT, they will be able to refer you to a suitable therapist. It’s important that your therapist is trained and qualified to use CBT. A number of different healthcare professionals are specially trained to use this type of therapy. These include clinical psychologists, psychiatrists (doctors who specialise in identifying and treating mental health conditions), mental health nurses and social workers.

CBT can help people with certain emotional or physical conditions. It can be particularly helpful if you have depression, anxiety or an eating disorder. Research shows that CBT can be just as helpful as taking medicines for mild to moderate depression. It may also help to reduce your risk of experiencing these problems again (known as a relapse).

Research shows that CBT can also be effective at reducing depression and pain in people with chronic pain conditions.

Self-help CBT may be effective on its own, but it usually works better if you have the support of a healthcare professional.

To start with, your CBT therapist will ask about your background and how you’re currently feeling.They will work with you to identify your current thoughts and issues, so you can discuss and focus on this, rather than events in your past.

You learn to make sense of your thoughts and actions by breaking them down into smaller areas. This will allow you to see how they’re connected and how they affect you.

Your CBT therapist will show you practical techniques so you can identify how you’re thinking and how this affects your feelings and behaviour. You will learn to challenge negative ways of thinking and how to react more positively. You will then explore other ways of dealing with a distressing situation.

Your therapist may suggest that you keep a diary each day to identify how you react to certain events or thoughts. You can note down when you feel distressed; what’s triggered this and your mood and thoughts at the time. You can also note whether you experienced any physical symptoms too, such as pain or low energy levels. This will help you identify any unrealistic or helpful thoughts, feelings or behaviour.

Your CBT therapist will usually set you homework between your sessions. This involves applying what you’ve discussed in the sessions to your daily life. You may start to question unhelpful thoughts and replace them with more helpful ones. You may also recognise events or actions that could make you feel worse and do something more helpful instead. You won’t be asked to do anything you don’t feel comfortable with.

When you have CBT, you learn specific skills to improve your quality of life. You then continue to practise what you’ve learnt on your own once you finish the series of sessions.You can use these skills for the rest of your life. But if you notice your symptoms are returning, you can go back to the therapist for some more sessions.

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CBT can be a challenging treatment. You must feel ready to actively change your thoughts and behaviour for it to be successful. It isn’t a quick fix. It takes time and you have to work at it. You may find it difficult to concentrate and stay motivated at first. You may also feel a bit anxious. But the right therapist will put you at ease and make sure your sessions work for you.

It’s important to remember that CBT isn’t for everyone. You may find another treatment that works better for you. Your doctor will discuss various options with you.

CBT is the first treatment a doctor will choose for children and teenagers with an anxiety disorder. It’s also used for children with other mental health disorders, such as depression, bipolar disorder and obsessive-compulsive disorder (OCD).

If your GP thinks CBT could benefit your child, they may refer them for treatment. Speak to your GP for more information.

Medical professionals follow a code of medical practice to ensure your details are kept confidential and are only passed on to people involved in your care. What you discuss in your CBT sessions won’t be discussed with anyone else unless you give your therapist specific permission to do so.

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) keeps a list of approved and qualified therapists. CBT therapists, who are members of the BABCP, must follow the Standards of Conduct and Ethics when they provide CBT as a treatment. This includes maintaining confidentiality.

Yes, you can do CBT using a computer programme or with self-help books. There are also apps available to download to your smartphone if you have one.

More information

You may find computerised CBT helpful if you have mild symptoms or don’t want to see a therapist.

In England and Wales, the NHS has approved two computer-based CBT programmes. Fear Fighter is specifically for people who have phobias or panic attacks. Beating the Blues is aimed at people who have depression.But to get access to these programmes, your GP will need to refer you.

There are a number of self-help books for people with conditions such as depression. If you would like to try this approach, your CBT therapist or GP may be able to recommend a suitable one.

The Royal College of Psychiatrists also suggests using the following free online CBT courses.

Treatment of depression and bipolar disorder. Treating and preventing adolescent mental health disorders: what we know and what we don’t know. A research agenda for improving the mental health of our youth (online). Oxford medicine Online. oxfordmedicine.com, published August 2012

Treatment of anxiety disorders. Treating and preventing adolescent mental health disorders: what we know and what we don’t know. A research agenda for improving the mental health of our youth (online). Oxford medicine Online. oxfordmedicine.com, published August 2012

Standards of conduct, performance and ethics. British Association for Behavioural and Cognitive Psychotherapies. www.babcp.com, accessed 9 March 2016

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